Academic journal article Indian Journal of Psychiatry

The Assessment of Insight across Cultures

Academic journal article Indian Journal of Psychiatry

The Assessment of Insight across Cultures

Article excerpt

Byline: K. Jacob

The assessment of insight is a part of the routine clinical examination for people with mental illness. Such assessment, by psychiatrists, is based on the current definitions of insight, which rely on western notions of health and illness. This paper discusses the recent findings of illness perspectives of people with a variety of physical diseases and mental disorders from India. Studies on insight in schizophrenia and bipolar disorders also examined explanatory models of illness among patients, relatives, and the general population. The findings argue for the fact that the assessment of insight should be against the local cultural standards rather than universal yardsticks. The assessment of insight should evaluate awareness, attribution, and action. People with psychosis who are able to re-label their psychotic experience, offer non-delusional explanations for changes in themselves, which correspond to beliefs about illness held by the subculture, admit to the need for restitution, and seek locally available help, can be said to possess insight. The results recommend the use of universal conventions to assess insight in people with psychosis rather than the use of uniform criteria.

Introduction

The assessment of insight in people with schizophrenia and other psychiatric illness is an important part of the mental status examination. Studies of schizophrenia in different regions of the world have documented "lack of insight" across cultures. [sup][1] However, the issues related to insight are complex and research argues that the traditional all-or-none approach and even the more recent recommendations, which employ universal criteria across multiple dimension, need re-evaluation.

Defining insight

Many attempts at defining insight have been recorded in the literature. Some current definitions of insight include the following.

*"The conscious recognition of one's own condition." [sup][2] *"The degree of personal awareness and understanding of illness." [sup][3]" *A person's capacity to understand the nature, significance and severity of his or her own illness." [sup][4]

Grades of insight ranging from complete denial to true emotional insight have been suggested. [sup][5] These grades include

a. Complete denial of illness

b. Slight awareness of being sick and needing help but denying it at the same time.

c. Awareness of being sick but blaming it on others, external factors, or medical or unknown organic factors.

d. Intellectual insight: Admission of illness and recognition that symptoms or failures in social adjustment are due to irrational feelings or disturbances, without applying that knowledge to future experiences.

e. True emotional insight: Emotional awareness of the motives and feelings within and of the underlying meaning of symptoms, whether the awareness leads to changes in personality, and future behavior; openness to new ideas and concepts about self and important people in the person's life.

Insight has implications for and impact on the patient's life, functioning, and on treatment compliance.

Traditional definition and implication

Traditionally insight has been defined as "the correct attitude to morbid change in oneself and the realization that the illness is mental". [sup][6] Jaspers had also discussed insight in similar terms. [sup][7] The traditional point of view supports the contention that insight is absent in psychosis and that it is an all or none phenomenon. For example, 97% of patients examined in the International Pilot Study of Schizophrenia did not have insight. [sup][1]

The acknowledgement of a mental illness by the patient was cardinal to diagnosis of the presence of insight. Insight is briefly assessed by instruments such as the positive and negative syndrome scale. [sup][8] The absence of insight was considered an important part of all psychoses including schizophrenia. …

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